Introduction
Crimean Congo haemorrhagic fever virus (CCHFV), is a member of the genus Nairovirus and Bunyaviridae family. Crimean Congo haemorrhagic fever (CCHF) is one of a group of arthropod-borne viral diseases producing acute, sometimes fatal febrile and hemorrhagic symptoms. Initially involving the nervous system, disease may in severe cases progress to vascular disorders such as profuse diapedesis hemorrhages, brain edema, general malaise, and ultimately cardiac arrest (Wilson et al., 1990). The major transmission of the virus is mediated by Hyalomma ticks; it can also be transmitted by squashing ticks, contact with contaminated secretions, blood and sera of patients and viremic animals (Swanepoel et al., 1987; Bosan et al., 2000; Burt et al., 1997; Whitehouse, 2004; Chinikar et al., 2004; Papa et al., 2004). Health workers, relatives of CCHF patients, people working with animals and animal products (shepherds, animal care workers, veterinarians and slaughterhouse workers) and people that had tick bites in CCHF endemic areas are under high risk of being infected by CCHF. Serious endemic CCHF outbreaks have been reported in countries from Europe, Asia and Africa (Whitehouse, 2004; Flick and Whitehouse, 2005; Papa et al., 2004).

1 Case report
The disease started on July 12, 2008, a 22-year-old tourist woman, presented at a local health outlet with high grade fever accompanied with chills, severe headache, dizziness, photophobia, neck pain, myalgia and arthragia.

In the first examination, her vital signs included a high body temperature of 40℃. Two days later, she developed gastrointestinal symptoms including nausea, vomiting, non-bloodily diarrhea and abdominal pain.

2 Results
Regression analysis was performed on the optical density (OD) data of sera, the OD of sample were above 0.40 and considered as a strong positive (++).

3 Discussion
Endemic outbreaks of CCHF have been reported in Turkey between 2002 and 2008 with averages of 5% mortality (Carhan et al., 2008). Seroprevalence of Crimean-Congo hemorrhagic fever (CCHF) in risk groups was carried out in Tokat Province of Turkey (2006-2007). Researchers reported 41 cases of CCHF with one death in July 2005 in Turkey's Yozgat Province, and 50 death cases were reported in Turkey in August 2008 due to CCHF. According to Ministry of Health of Turkey 3 128 Crimean–Congo hemorrhagic fever cases were observed between 2002 and 2008. In Kosovo's Kosovo Polje hospitals reported 70 cases of CCHF with four deaths in May 2010 (Prajapati et al., 2011).

The higher prevalence of CCHF in countries such as Albania, Bulgaria, the former Yugoslavia, Ukraine, Georgia, Tacikistan, Iran, and Pakistan was reported (Whitehouse, 2004; Chinikar et al., 2004; Papa et al., 2004).

The enzyme-linked immunosorbent assay (ELISA) was a highly sensitive and specific tool for CCHF diagnosis (Garcia et al., 2006). 

CCHV is a zoonotic disease that affect  people who come into contact with livestock and tick and in endemic areas, animals infection appear to be one of the best indicators of risk to human infection (Kuljic- Kapulica, 2004 ).

4 Conclusion
We conclude from this report that rapid diagnosis of CCHF is important to prevent the spread of CCHF virus among the health people.

5 Materials and Methods
Peripheral blood sample was collected at the onset of the disease using Vacutainer tubes. Blood sample were centrifuged at 1 500 rpm for 30 min, serum were separated, transferred into 2 mL Eppendorf micro-centrifuge tubes and stored at –20℃ until used for the ELISA.

Detection of CCHFV antigen in serum samples was performed with the use of a commercially kit according to the manufacturer’s recommendations. Standardized optical density (OD) values were calculated as follows: standardized OD = (raw OD of sample － raw OD of negative control) / (raw OD of positive control － raw OD of negative control).

Values < 0.22 were considered negative, values > 0.35 positive (+) and values > 0.35 strong positive (++). Samples with OD values from 0.22 to 0.40 were retested with another serum.

Acknowledgements
I would like to thank the University of Istanbul for their supporting.

References
Bosan A.H., Kakar F., Dil A.S., Asghar H., and Zaidi S., 2000, Crimean-Congo hemorrhagic fever (CCHF) in Pakistan, Dis Surveil, 2: 4-5

Burt F.J., Swanepoel R., Shieh W.J., Smith J.F., Leman P.A., Greer P.W., Coffield L.M., Rollin P.E., Ksiazek T.G., Peters C.J., and Zaki S.R., 1997, Immunohistochemical and in situ localization of Crimean-Congo hemorrhagic fever (CCHF) virus in human tissues and implications for CCHF pathogenesis, Arch. Pathol. Lab. Med., 121: 839-846 PMid:9278612

Carhan A.Y., Ozkaya E., and Ertek M., 2008, A preliminary report on Crimean-Congo haemorrhagic fever in Turkey, March - June, Euro. Surveil., 13: 18953 PMid:18761892

Chinikar S., Persson S.M., Johanson M., Bladh L., Goya M., Housmand B., Mirazimi A., Plyusnin A., Lundkvist A., and Nilsson M., 2004, Genetic analysis of Crimean-Congo Hemorrhagic Fever Virus in Iran, J. Med. Virol., 73: 404-411 http://dx.doi.org/10.1002/jmv.20106 PMid:15170636

Flick R., and Whitehouse C.A., 2005, Crimean-Congo hemorrhagic fever virus, Curr. Mol. Med., 5: 753-760 http://dx.doi.org/10.2174/156652405774962335 PMid:16375710

Garcia S., Chinikar S., Coudrier D., Billecocq A., Hooshmand B., Crance J.M., Grain D., and Bouloy M., 2006, Evaluation of Crimean-Congo Hemorrhagic Fever virus recombinant antigen expressed by Semliki Forest suicide virus for IgM and IgG antibody detection in human and animal sera collected in Iran, J Clin Virol., 35(2):154-159
http://dx.doi.org/10.1016/j.jcv.2005.02.016 PMid:16087395

Kuljic-Kapulica N., 2004, Emerging diseases Crimean-Congo Hemorrhagic Fever Virus (in Serbian), Med Pregl, 57 (9-10):354-356
http://dx.doi.org/10.2298/MPNS0410453K PMid:15675618

Papa A., Christova I., Papadimitriou E., and Antoniadis A., 2004, Crimean-Congo hemorrhagic fever in Bulgaria, Emerg. Infect. Dis., 8:1465-1467 
http://dx.doi.org/10.3201/eid1008.040162 PMid:15496250 PMCid:3320408

Prajapati D.S., Patel K.R., Sen D.J., Patel S.J., and Grag C.S., 2011, Crimean-Congo hemorrhagic fever from tick- borne viral disease, Pharmacie Globale, IJCP, 3(02):1-6

Swanepoel R., Shepherd A.J., Leman P.A., Shepherd S.P., McGillivray G.M., Erasmus M.J., Searle L.A., and Gill D.E., 1987, Epidemiologic and clinical features of Crimean-Congo hemorrhagic fever in southern Africa, Am J Trop Med Hyg., 36(1):120-132 PMid:3101525

Whitehouse C.A., 2004, Crimean-Congo hemorrhagic fever, Antiviral Res., 64:145-160 
http://dx.doi.org/10.1016/j.antiviral.2004.08.001 PMid:15550268

Wilson M.L., and Digoutte M., 1990, Ecology and epidemiology of Criman-Congo haemorrhagic fever virus transmission in the Republic of Senegal, Annual Report, Institute Pasteur, Dakar, Senegal